Geriatric and physically oriented rehabilitation improves the ability of independent living and physical rehabilitation reduces mortality: a randomised comparison of 538 patients.

Objective: To examine effects of physical and geriatric rehabilitation on institutionalisation and mortality after hip fracture.

Design: Prospective randomised study.

Setting: Physically oriented (187 patients), geriatrically oriented (171 patients), and health centre hospital rehabilitation (180 patients, control group).

Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.

Background: This study compared mid-term functional and radiologic results of syndesmotic transfixation with no fixation in supination external rotation (SER) ankle fractures with intraoperatively confirmed syndesmosis disruption. Our hypothesis was that early-stage good functional results would remain and unfixed syndesmosis disruption in SER IV ankle fractures would not lead to an increased incidence of osteoarthritis.

Methods: A prospective study of 140 operatively treated patients with Lauge-Hansen SER IV (Weber B) ankle fractures was performed.

The mechanism of action of induced membranes in bone repair.

Background: Inducement of foreign-body granulation tissue is a relatively novel therapeutic modality in bone repair. A two-stage bone reconstruction method, known as the Masquelet technique, combines inducement of a granulation tissue membrane and subsequent bone autografting as a biphasic technique allowing reconstruction of large bone defects. In light of their already well-characterized osteogenesis-improving capabilities in animals, we performed this translational study to investigate these membranes in patients.

[When is ankle fracture treatable without surgery?].

Stability of a fractured ankle is the most important factor when considering the choice between operative and non-operative treatment. Depending on the mechanism of injury, the most common type of ankle fracture, spiral fracture of the lateral malleolus (Weber B) may be stable or unstable. It can be treated conservatively, provided that the shape of the ankle joint has remained intact in both projections and there is neither significant injury of deep deltoid ligament nor another fracture within the ankle region.

Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.

Background: This study was designed to assess whether transfixion of an unstable syndesmosis is necessary in supination-external rotation (Lauge-Hansen SE/Weber B)-type ankle fractures.

Methods: A prospective study of 140 patients with unilateral Lauge-Hansen supination-external rotation type 4 ankle fractures was done. After bony fixation, the 7.

Intraoperative assessment of the stability of the distal tibiofibular joint in supination-external rotation injuries of the ankle: sensitivity, specificity, and reliability of two clinical tests.

Background: This study was designed to assess the sensitivity, specificity, and interobserver reliability of the hook test and the stress test for the intraoperative diagnosis of instability of the distal tibiofibular joint following fixation of ankle fractures resulting from supination-external rotation forces.

Methods: We conducted a prospective study of 140 patients with an unstable unilateral ankle fracture resulting from a supination-external rotation mechanism (Lauge-Hansen SE). After internal fixation of the malleolar fracture, a hook test and an external rotation stress test under fluoroscopy were performed independently by the lead surgeon and assisting surgeon, followed by a standardized 7.

Stability criteria for nonoperative ankle fracture management.

Background: This study was designed to see if stability based criteria are useful in choosing between nonoperative and operative treatment of ankle fractures.

Materials And Methods: One hundred sixty ankle fractures in skeletally mature patients were retrospectively analyzed to obtain an epidemiological profile in a population of about 130,000. One hundred thirty patients had followup of more than 2 years.

Surgical treatment of extra-articular or simple intra-articular distal tibial fractures: external fixation versus intramedullary nailing.

Objective: To compare intramedullary nailing (IMN) with external fixation (EF) in the treatment of tibial shaft fractures located within 5 cm of the ankle.

Setting: University teaching hospital.

Design: Retrospective comparative study.

Bone morphogenetic proteins in open fractures: past, present, and future.

The management of open fractures continues to be complicated by high rates of treatment failure and significant patient disability and dissatisfaction. The use of bone morphogenetic proteins (BMPs) in the treatment of open fractures has been assessed by a number of different clinical trials, both in the acute management of open fractures and in the delayed reconstruction of bone defects secondary to open fracture. This review describes the scientific basis for the use of BMPs in open fractures, reviews the current evidence for their use in open fractures, provides grades of recommendation for the different uses of BMPs in open fractures, and identifies important areas for additional research.

Acromial shape in asymptomatic subjects: a study of 305 shoulders in different age groups.

Background: It has been reported that acromial morphology and age have an independent association with rotator cuff pathology. In a recent study, we found the acromial angle of patients with stage III impingement syndrome (tear in the rotator cuff, according to the Neer classification of shoulder impingement syndrome) to be significantly greater than the acromial angle of their age-matched healthy controls.

Purpose: To find out if acromial shape also changes, i.

Application of BMP-7 to tibial non-unions: a 3-year multicenter experience.

The effective treatment of the often debilitating, longlasting and large-asset-consuming complication of fracture non-unions has been in the centre of scientific interest the last decades. The use of alternative bone substitutes to the gold standard of autologous graft includes the osteoinductive molecules named bone morphogenetic proteins (BMPs). A multicenter registry and database (bmpusergroup.

Traumatic First Metatarsal Bone Loss Treated with a Staged Method Using an Antibiotic Cement Spacer and Subsequent Autografting: A Case Report.

Fractures with bone loss are rare. A staged method of using bone cement as a spacer and subsequent autografting has been used successfully to treat traumatic bone loss of long bones. We report a case of traumatic bone loss of the 1st metatarsal bone that was treated successively with a staged method of using antibiotic-impregnated bone cement as a spacer in the primary phase and cancellous autografting in second-stage surgery.

Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss: 22 of 23 fractures healed after 5-20 months.

Introduction: The vascularity of surrounding soft tissues, which is related to muscle cover, is important for the healing of traumatic bone loss. Muscle cover on the distal tibia is limited compared to the diaphyseal and proximal tibia, and delayed healing of fractures in this area is common. We evaluated the healing of traumatic bone loss in the proximal, diaphyseal, and distal tibia.

External fixation of tibial pilon fractures and fracture healing.

Distal tibial fractures are rare and difficult to treat because the bones are subcutaneous. External fixation is commonly used, but the method often results in delayed union. The aim of the present study was to find out the factors that affect fracture union in tibial pilon fractures.

Two-ring hybrid external fixation of distal tibial fractures: a review of 47 cases.

Background: The healing of a metaphyseal fracture line is a major problem in cases of distal tibial fracture treated with external fixation.

Methods: Forty-seven distal tibial fractures treated with two-ring Ilizarov hybrid external fixation (16 AO/OTA type A and 31 type C, 10 open) were followed up. Fracture reduction and union time was evaluated and IOWA and RAND 36-Item Health Survey scores were used to assess functional outcome.

Hook-plate fixation of unstable lateral clavicle fractures: a report on 63 patients.

Background: Hook-plate fixation of unstable lateral clavicle fractures has given promising results in previous reports, but numbers of patients have been small. We assessed the results of this technique in 63 patients.

Patients And Methods: 63 patients with unstable lateral clavicle fractures were operated on at Oulu University Hospital during 1997-2004, using a clavicle hook-plate.

Early revision after hemiarthroplasty and osteosynthesis of cervical hip fracture: short-term function mortality unchanged in 102 patients.

Background: There is no consensus on whether osteosynthesis or hemiarthroplasty is preferable in the treatment of cervical hip fractures. Osteosynthesis is associated with more reoperations than hemiarthroplasty but there is little information available on the consequences of these reoperations.

Patients And Methods: We studied the effect on mortality, hospital stay and functional outcome of revision performed within 4 months of primary surgery with hemiarthroplasty or osteosynthesis for cervical hip fracture.

Nonbridging external fixation in the treatment of unstable fractures of the distal forearm.

Introduction: Unstable fractures of the distal forearm often require surgical treatment to restore the normal anatomy and function. We have used a relatively new technique, nonbridging external fixation, in the treatment of these fractures in our hospital during the past few years. Our results are presented here.

Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation.

During 1988-1999 39 unstable fractures of the distal clavicle (Neer 2) were operated on in Oulu University Hospital. Kirschner wire (K-wire) fixation was used in 22 cases and a clavicular hook plate in 17. Shoulder symptoms and function were assessed using self-administered questionnaires devised by L'Insalata et al.